Bacteriemia por Stenotrophomonas maltophilia en niños: análisis de 10 años / Stenotrophomonas maltophilia bacteremia in children - A 10-year analysis

Stenotrophomonas maltophilia es un microorganismo gramnegativo, multirresistente. La información sobre la bacteriemia por S. maltophilia en niños es limitada. Se revisaron los datos de 10 años de un hospital de niños de alta complejidad. Se incluyó a niños de 0 a 18 años con hemocultivos o cultivos del catéter positivos. Se identificaron 20 cepas de S. maltophilia en 12 niños con infección confirmada, cuya mediana de edad fue 28 meses (intervalo: 3,1-187,3). El índice de antibioticoterapia previa fue 83 %, con una mediana de tres antibióticos (intervalo: 0­7) en los 30 días previos a la bacteriemia por S. maltophilia. La infección relacionada con el catéter fue la principal fuente de infección (8/12). La mortalidad fue de 4/12; y en dos casos, estuvo asociada con neumonía. S. maltophilia puede considerarse un agente muy invasivo productor de bacteriemia en niños con enfermedad preexistente expuestos a antibióticos durante una hospitalización prolongada.

Stenotrophomonas maltophilia is a multidrug-resistant, Gram-negative, and biofilm-forming pathogen. Information is limited concerning S. maltophilia bacteremia in children. Clinical data and microbiological test results collected in a tertiary children's hospital over a ten-year period were reviewed. Children 0­18 years old who had positive clinical specimen, blood and/or catheter cultures were included. We identified 20 S. maltophiliaisolates from 12 pediatric patients with confirmed infections. The median age was 28 months (range: 3.1-187.3). The rate of previous use of antimicrobial therapy was 83 %. The median antibiotic number was 3 (range: 0­7) within 30 days prior to onset of S. maltophilia bacteremia. Catheter related infection was the main infectious source (66.6 %). The mortality rate was 33.3 %. The death of two non-survivors was associated with pneumonia. S. maltophilia should be considered a breakthrough agent for bacteremia in children with underlying disease exposed to broad-spectrum antibiotics during long-term hospitalization

Caracterización de neumonía por Staphylococcus aureus meticilino resistente en hospital militar de alta complejidad / Characterization of Methicillin-resistant Staphylococcus aureus pneumonia in high complex militar hospital

Introducción: Por su capacidad de resistencia, las cepas de Staphylococcus aureus resistentes a la meticilina (SAMR) representan un reto importante en la terapéutica. Se desarrolló este estudio con el fin de caracterizar la población con neumonía por SAMR del Hospital Militar Central. Métodos: Se condujo un estudio descriptivo de corte transversal, en pacientes con diagnóstico de neumonía bacteriana con aislamiento microbiológico positivo para SAMR. El análisis de los datos se realizó a través de medidas de tendencia central y de dispersión. Resultados: Durante el periodo de 4 años de estudio hubo 211 aislamientos correspondientes a S. aureus de los cuales 22 correspondieron a neumonía bacteriana por SAMR. La neumonía nosocomial fue la forma más frecuente de presentación (54,5%), seguida por neumonía adquirida en la comunidad (36,3%). El 36,3% de los pacientes eran militares activos, el 31,8% militares retirados o civiles. La frecuencia de comorbilidades fue del 92,3% siendo la enfermedad renal crónica y malignidad las más frecuentes. Conclusión: Desde el punto de vista clínico la neumonía por SAMR se caracterizó por una mayor cantidad de pacientes jóvenes y sin comorbilidades contrastando con neumonía nosocomial que se caracterizó por una población de más edad y con mayor prevalencia de comorbilidades.

Introduction: Strains methicillin-resistant Staphylococcus aureus (MRSA), to be resistant to most beta-lactam available and different families of antibiotics, represent a major challenge in therapeutics; for this reason, it is necessary to conduct studies to characterize better patients with MRSA infection. Methods: A descriptive study of cross section of patients diagnosed with bacterial pneumonia with positive microbiological isolation for MRSA was conducted by reviewing medical records and susceptibility testing relevant demographic and clinical data were extracted. The data analysis was conducted through measures of central tendency and dispersion. Results: During the period of 4 years of study; there were 211 isolates corresponding to S. aureus; of which 22 were for MRSA bacterial pneumonia. Nosocomial pneumonia was the most common presentation (54,5%); followed by community-acquired pneumonia (36,3%). 36,3% of patients were military personnel, 31,8% retired military or civilians. The frequency of comorbidities was 92,3% being chronic kidney disease and the most common malignancy. Conclusion: From the clinical point of view MRSA pneumonia it was characterized by a greater number of young patients without comorbidities; which contrasted with nosocomial pneumonia was characterized by an aging population and higher prevalence of comorbidities.

The role of fiberoptic bronchoscopy in diagnosis and treatment of mycoplasma pneumoniae pneumonia associated with atelectasis in children / 医学研究生学报

Objective Mycoplasma pneumoniae is one of the main pathogens of community-acquired pneumonia in children and teenagers , which may cause mycoplasma pneumoniae pneumonia ( MPP) .Atelectasis is one of the most common manifestations of MPP.The aim of the article was to evaluate the diagnostic and therapeutic value of fiberoptic bronchoscopy ( FB) in children with MPP associated with atelectasis . Methods Retrospective analysis were made on clinical data and FB records of 99 cases of hospitalized children with MPP associated with atelectasis from August 2010 to December 2012 . Results The positive rate of MP-DNA was 92.9%(92/99) in bronchoalveolar lavage fluid (BALF), and the positive rate of MP-Ab-IgM in serum was 68.7%(68/99).All pa-tients showed obviously bronchial mucosa congestive edema during FB examination .The results are as follows:bronchial phlegm bloc-king in 31 cases (31.3%), lumen inflammatory stenosis in 22 cases (22.2%),mucosal ulcer change in 7 cases(7.1%) and mucous nodular change in 3 cases (3.0%).4 weeks after being treated with bronchoalveolar lavage (BAL), only 3 cases remained in atelec-tasis, the partial and complete re-expansion rate reaching 96.5%(82 of 85). Conclusion The positive rate of BALF MP-DNA de-tection technology for the diagnosis of MP infection is higher than that of serum MP-Ab-IgM examination .Early interventional therapy by FB can shorten the course of disease and promote the lung re-expansion in children with MPP associated with atelectasis .

Cost Minimization Analysis of Sequential Treatment of Children Community-acquired Pneumonia with Azithromycin / 药物流行病学杂志

Objective:To:investigate the curative effects and cost of sequential treatment of children communityacquired pneumoni(CAP) with azithromycin. Method:118 cases of CAP from this hospital were divided into two groups: sequential azithromycin therapeutic group (Group A) and iv ceftazidime group (Group B). Their clinical effect was observed and cost minimization analysis was carried out. Result:The total costs were 612?7. 3 yuan and 819?8. 2 yuan(P 0.05) in Group A and Group B respectively. Conclusion: The sequential azithromycin scheme is a better one to treat CAP.

A Case of Pneumocystis Carinii Pneumonia with Histopathologic Finding of Bronchiolitis Obliterans with Organizing Pneumonia in Patient with AIDS / 결핵

PCP remains the leading cause of deaths in patients with AIDS. As familiarity with PCP increases, atypical manifestations of the diseases are being recognized with greater frequency. There are following "atypical" manifestations of PCP; 1) interstitial lung response that include diffuse alveolar damage, bronchiolitis obliterance, interstitial fibrosis, and lymphoplasmocytic infiltrate 2) striking localized process frequently exhibiting granulomatous features 3) extensive necrosis & cavitation 4) extrapulmonary dissemination of the disease. A wide variety of pathologic manifestations may occur in PCP in human immunodeficiency virus- infected patienst and that atypical features should be sought in lung biopsies from patients at risk for PCP. We had experienced a case of PCP, which presented with severe hypoxia, progressive dyspnea and fine crackles. It was diagnosed as PCP in AIDS with manifestation of BOOP by open lung biopsy and showed good response to Bactrim & corticosteroid therapy.